Fallen Timbers Internal Medicine, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

35072198 Issued in OH

Legal business name

FALLEN TIMBERS INTERNAL MEDICINE, LLC

Practice address

6450 Wheatstone CT
Maumee, OH 43537-9402

Phone

(419) 866-6200

Fax

(419) 866-7170

NPI assigned

Jan 11, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Nizar Y Daboul, MD

Title

Owner President

Phone

(419) 866-6200

Specialties & licenses 1

Addresses

Other identifiers 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194998400000",
    "number": "1205986247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6450 WHEATSTONE CT",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435379402",
            "telephone_number": "419-866-6200",
            "fax_number": "419-866-7170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6450 WHEATSTONE CT",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435379402",
            "telephone_number": "419-866-6200",
            "fax_number": "419-866-7170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FALLEN TIMBERS INTERNAL MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-11",
        "last_updated": "2007-11-14",
        "status": "A",
        "authorized_official_last_name": "DABOUL",
        "authorized_official_first_name": "NIZAR",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "419-866-6200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35072198",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2008562",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2633396",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eye Institute of Northwestern Ohio, Inc.
• Christine A. Fair, LPC, PHD
• Kevin Falk
• Fallen Timbers Family Eye Care
• Fallen Timbers Family Physicians
• Desirae Danielle Felgner
• Charles George Felix, M.D.
• Tiffany Fellers, RBT
• Karl Shane Fernandes, MD
• Shaila Patel Fernandes, M.D.

• Internal Medicine Physician in Maumee, OH
• Providers in Maumee, OH by specialty
• Internal Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.